As any patient awaiting a rheumatology appointment can tell you, there just aren’t enough rheumatologists to go around. Waitlists can be months to years long, wreaking havoc on patients’ joints, functional capacity and quality of life. The access situation is dire enough to prompt posts on patient support websites about how to handle the waiting period to see a rheumatologist.1
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Unfortunately, the problem is getting larger. As the population ages and senior rheumatologists retire, demand for rheumatologic care is projected to be more than twice the available supply in 2030, according to the 2015 ACR Workforce Study.2 Communities with already-limited access to care, such as rural areas and states lacking Medicaid expansion, will be hit even harder.
Telehealth is one strategy to improve access to specialty care and reduce waiting times. Electronic consultations, or e-consults, are examples of an evolving telehealth modality with the potential to help patients access rheumatologic care in a cost-effective and efficient manner.
What’s an e-Consult?
In simple terms, e-consults are curbside consults with another provider—the sort of thing you’re probably already doing in the clinic hallway or via email, but conducted in a Health Insurance Portability and Accountability Act (HIPAA) compliant and billable fashion. For example, imagine a primary care provider has a question for a rheumatologist that would be better answered following a brief review of the patient’s chart. The question could be as simple as “Does this lab result matter?” In an ideal world, such a question would be answered in less than 24 hours. E-consults could help achieve this.
Although a formal definition does not yet exist, an e-consult involves an asynchronous, provider-to-provider electronic exchange within a shared electronic health record or HIPAA-compliant web-based platform. Specialists receive access to clinical notes, labs and studies to aid in answering the consulting question. The exchange then becomes a part of the patient’s permanent record.3
E-consults differ from synchronous telemedicine visits in that the specialist has no direct patient contact. The specialist offers recommendations, but enactment of treatment plans is at the discretion and responsibility of the original provider.
Experience from an e-Consult Company
Daren Anderson, MD, founded the e-consult company ConferMED, Middletown, Conn., in 2015. With more than 17 years of experience as an internist caring for patients in safety net communities, Dr. Anderson noticed that “a main driver of inequity in healthcare outcomes was poor access, long wait times and poor communication with specialists,” he says. In addition, “rheumatology is the number one most requested e-consult specialty in the Central Valley of California, where wait times average nine to 12 months to see a rheumatologist … who may be several hours away by car.”